Words and Time.

" Thank you so much, you really put his mind at rest, he now understands"

Time taken and given to C&YP in hospital is a rare commodity, I say this as in an ever changing and fast paced environment such as acute inpatient care- I believe it is, this is not to single out an individual , or team but an observation.

I have heard such conversations, they wished there was a little more time, to explain, adjust, prepare themselves as HCP's as well as their patients and families.
This is not always possible- what if it presents as an emergency?

I feel like I want to turn this on its head a little, so stay with me on this!

As a Specialised Play Practitioner I observe the impact a hospital admission or procedure has on C&YP when it is an acute admission or procedure.
All of a sudden they are informed that a procedure, operation or blood test needs to happen.
At that very moment- everything changes for them, their families and the HCP's caring for them.

As HCP's we don't always know significant history in terms of previous experience or trauma.

However I observe the fear, the apprehension,  I listen to the questions, the slight adjustment in level of voices, pitch, volume- I watch intently to the change in size of their pupil reaction, the flushed colour in their cheeks, the silence that takes over them.
The body language, the breathing rate.

All this occurs immediately after they are told about the procedure- I call this the "golden 5 minutes"- in this time, whilst the HCP's are preparing themselves, as they too experience all or some of the above-the C&YP needs preparing- so how we manage this next episode of care is crucial for us as practitioners, and for the child or young person.

Simple language to explain "what happens next"
Words are so very important at this stage- how we describe things, there are some words that we should not use.

Key words are the only thing parents and C&YP remember, I discussed this during the week with a family, they shared with me  " tube" " mask"  " blood"  " prick" being the most they remember in times of fear.

Tube, Mask, Blood, Prick.

This was a child who will have to come into hospital on a regular basis, for the rest of his life, and these are the words he will remember each time he prepares to visit the hospital.

What if words are not the medium- Photographs, drawings, signs, PECS (picture exchange communication system), Makaton , BSL and so on.

The "golden 5 minutes" should be for the need to know now information.
Why, What, When, How.

These are ideas, and a continual work in progress- because they can and should be adapted to each individual healthcare setting, and individual child or young person.
I should also say that I do observe, HCP's taking the time - and the results speak for themselves.

Change in practise, communication and preparation is always an adventure- it asks us to think differently, use words and language we may not have previously used ,or indeed how we would choose to describe events or actions, at times we might feel silly or self conscious, but we as adults can process that- C&YP cannot when fear and trauma takes over.

Recall what I said about turning this subject on its head........................ what would the outcomes be?

If we have a "golden 5 minutes" just imagine what impact that would have in "time" spent calming a child or young person down, when they refuse to allow HCP's to carry out observations, procedures, examinations?
Time spent encouraging a child to allow that process to happen.



If the "time" was there to prepare as HCP's then it should be there for the C&YP?
Health Play Specialists, Play Specialists, Play workers can be the time keepers.
We are also really good at sharing our skills and knowledge with the wider MDT.

 Trauma in Children is a deep and ever evolving study and research experience, - when we meet C&YP and their families for the first time we do not know what trauma, if any they have experienced, or the family history, but research and studies show us that it impacts on their very being, and ability to cope with new experiences, and how we draw on those, the fight or flight we display.

There are many battles that our patients may have fought and won, there are also many that they are still fighting and living with on a daily and hourly basis when they reach us.

Play4C&YP will be taking a few weeks break, to recharge, to reconnect, and to read!
Recommended read................
Waking the Tiger= Healing Trauma
Peter A. Levine


Sian Spencer-Little

The Parent , The Patient ,The Teacher

I have observed this week creative, thoughtful, moving moments, sorrowful times, sadness and technical skills, experience and medical interventions.

I have witnessed my peers work long hours, with unfaltering  commitment, passion and compassion.

I have watched the bond between a child and their parents- I have been honoured to sit alongside and provide time and space- a moment of relief- of joy.

A smile, an eye movement- a moment of pain free bliss.

Then after- the time to reflect, to process- I look at the junior team of doctors and nurses - the expression on their faces- do they know they have just been part of a moment in time that could enhance to the very core their work- how they develop relationships with patients.

I look at the parents, the patients- and I know they have taught us this week.

I think about the 6C's- each and everyday I walk alongside healthcare and medicine.

I look to my left- to 2 HCP's who stand so still, but breathless, small beads of perspiration fall, the expression on their faces, of concern, of professionalism of care, of passion when an emergency arises.
Sometimes I catch my breath- sometimes I cannot believe that I get to come to work, and be part of this amazing team.

I think about storytelling, sharing experiences, moments in history that all pave the way to learning, and challenging how we react, what are the circumstances, and access to fears and feelings.

 

This week I have read many things- but this section from Dr Tanya Byron's book "The Skeleton Cupboard" stood out for me.

Many paragraphs stand out for me- particularly about hearing patients stories, and providing the platform for them to tell them.

 

I have also spent time sharing my story, with student nurses, junior doctors, they ask me why I work in the way that I do, how does this effect a hospital experience,  impact on the levels of care, what can they do to assist.

We have discussed the difference between changes in careers and how we explain the things that have impacted our lives, events, experiences and how they shape us as HCP's.

So I carry this with me- like a beacon of hope, of understanding and of learning

"When we are no longer able to change a situation- we are challenged to change ourselves"
Viktor E Frankl.


Sian Spencer-Little

 

The Art of Distraction Play.

Distraction in all it's different forms is an art form, but also an effective tool and skill in use by many of my Play Specialist colleagues, and indeed many HCP's.

When seeking a "definition" I have found  many focus on one point- and there is a huge difference.

"a thing that prevents someone from concentrating on something else."

Is one such explanation.

This in it's simplicity sounds a good solid definition. However when using Distraction Therapy with C&YP it takes on a whole new meaning and complexity.

I have my own way of describing it- it works for me- but won't for everyone.

A method, a tool for C&YP, an enabler, a "take some control" button.

Something that you keep in your pocket, and can pull out at very short notice!

For HCP's it's another element to add to the "Rucksack of Skills" we already carry in our working lives.

In our lives both at work and at play many of us become distracted- a piece of music, a book, a telephone conversation, social media ( my ever present distraction!) and  even cake! All these things can become very pleasant distractions from those tasks we are not too joyous to complete, then there are those distractions that become unpleasant- and difficult.

When working alongside C&YP it's important as a Specialsied Play Practitioner to acknowledge the levels of anxiety and identify triggers that may cause this anxiety to escalate.

It can be isolated.

History plays a large part, the environment , what words are used to describe things, images and time frames, pain and increase of symptoms are just some of the anxiety inducing elements that have been shared with me by C&YP and their families.

I use the art of distraction through out my working day, introductions in the morning, "look at that teddy bear- he is so cuddly- what's his name"

"#hello my name is Sian- but sometimes I am called "Nutnut" or "Nitty Nutty Nora"

"Hi- I get a sense that things are not right, what can you tell me so that I might be able to help and support you"

When supporting  examinations- often I look to the lead doctor to "join me" in my story building- the feedback from families and C&YP is that it shows they are "human beings"

"oh and a bit silly too"

This breakdowns massive fear inducing barriers and changes the images that C&YP build in their imaginations about hospitals and procedures.

 

When we gain consent to carry out invasive procedures on C&YP at the same time we are assessing the need or level of support they will require prior to starting- we also need to be asking them how they would like things to happen.

As HCP's striking up a conversation about their favourite colour, game, music, book is a great start.

Picking out something in the room- making up a story asking them to think of names, characters, what can happen next? Distraction, Pretend Play and Imagination- all have a place.

Acknowledging that right now- it's a bit rubbish, and working alongside those feelings with C&YP.

There are times - in emergencies when procedures need to happen quickly and safely, asking for input from a Health PlaySpecialist or practitioner will support that journey, the use of language, and the level of distraction required.

We are also skilled at supporting our medical and clinical collegeues, so that skills are shared and learning acquired.

 

In an everchanging fast paced approach to Social Media- there is some train of thought that write IPhones and IPads actually distract from the skills needed to carry out distraction.

Following your assessment of the mood, the anxiety level, the approach you will use- and the environment ........ A decision should be made by the HCP's 

My own view -I am the facilitator, the support mechanism for C&YP in times of anxiety, fear and pain- sometimes I am also their voice- and we must listen.

I have many skills- the teams I am part of, have many skills and I also need support to offer these - my complete focus is to minimalise trauma impact- for the child or young person sitting next to me- I use whatever I can that will enhance that experience and lessen the trauma.

IPads, Apps, Red noses, Pom-poms, Stickers, Bubbles, Music and Standing on one leg.

If it helps- then let's use it!

Suggested Apps- recommend by the C&YP! 

#justsayin!

• Minion Rush
• CBeebies Playtime and Story time
• Kids Doodle
• Jelly Splash
• Angry Birds- Starwars
• Peppa Pigs Paint box
• Hairy Phonics
• Four in a line
• Talking Pocoyo.

There are many more.........  please share them
These are all free!

Articles of further reading and exploration.

Interactive verses Passive Distraction for Acute Pain Management in Young Children
The role of selective attention and development 
Karen A. Wohlheiter; PhD; Lynnda M. Dahlquist; PhD | Disclosures

J Pediatr Psychol. 2013;38(2):202-212

Sian Spencer-Little.

Powerful, Evolving, Play Partnerships.

Making and forming active, co-productive partnerships is time consuming- but the benefits outweigh the negatives- outcomes are priceless, awe inspiring at times.
The negatives teach us, form us, allow us to improve our practise, impact on our very being, and in turn stay with us.

There are many professional partnerships that engage HCP's and inturn impact on the relationships of work in our lives and the way forward.
There are also many people we will meet,  along the way that will impact our lives forever.

Leaders, families, children and young people become my Powerful, Evolving, Play Partners.
They encourage me- and support me to tap into my inner self, my practise and my inner child, my creative self- this has an impact on the type of care I offer and give.

Play and its impact in Healthcare also evolves and changes, sometimes at an alarming rate, as HCP'S we work with a diverse and amazing range of individuals, patients, and professionals.
It also grows and collects inner strength as more is shared and experienced.

In recent months I have added to my learning, to the way I share my knowledge, I have been enriched by this experience, and this impacts on the way I can support C&YP and their families.
I take inspiration from many things to enhance my practise, to provide rich opportunities for specialised play moments.
I recall "Hunter Patch Adams"

" Waiting in line is a great opportunity to meet people, daydream or play"
 

I have had many conversations this week about the balance of life and work.
Particularly this week as we Welcome new doctors and nurses to our teams.

Some say that there should be a clear definable line that exists, to show when work starts and finishes, downtime should be present and what allows you joy and happiness should fill this downtime.

We spend many hours in our place of work, how do we as HCP's define downtime?

We all have different ways of managing and working through our "things to do" lists- are we realistically observing and recognising our stress levels.

I refer to this quote- as this is where I would sit- if there were a see-saw of work/downtime balance.

I recognise that there are many levels of stress, that this is real, it exists, and I can only comment on my experiences at work.
I have felt at times engulfed with workload- I turned to those who could support my passion.

When I spend time with C&YP, I feel an immense amount of joy, of contentment- in many ways they are my fuel, they enrich me as a person, and my life. 
I feel I am lucky to work in this field of care and support.

With the new doctors in mind I started to think about "3 enabling tips"
We can use these, everyone can..

1.
Practicing gratitude gives you a happiness advantage

you may be tired,  have a list that is forever being added to- but it is this list, this record of all that you are involved in - that is a driving force in your levels of happiness, sense of self and passion, even if none of the boxes get ticks.

The passion to engage, to make a difference, however small.

2. Each end of day/shift- 2 "moments" that will remind you in the months to come- just why we do this, this will be like an energy bar- for the tough times.

3. Find that someone or something, that you can spend 10mins with fuelling your inner child, that someone may be a human, an animal, a twitter buddy.
Dance, sing, draw, create, jump up and down, write, cook, explore, have a water fight with, walk, - It will impact on your training, it will encourage a healthy play outlet, it will enhance you as a HCP.



Downtime - for me its, writing, reading, exploring, playing.
It's my work- its who I am.


Sian Spencer-Little.

Trauma Sea's- Steady the Ship.

 

"The future depends on what we do in the present"

Mahatma Gandhi

 
 

The word trauma on its own can mean many things- we all could examine and explain it differently, its impact, it's loss, the anger and disbelief it produces.Research indicates to us that trauma in C&YP can have an impact on their development, ability to learn,emotional well being, resilience and their capacity to engage and trust.

There are some C&YP who are less effected than others we are informed- and we may witness this in our vocational  lives.... I would be bold enough to say that this is not entirely true.

 

It too has the same impact on adults alike, the extended family and the care givers.

I include those HCP's who observe and engage with C&YP who are in the midst of unimaginable trauma.

As a Specialised Play Practitioner (SPP) I see trauma in the many forms it takes.

The unstable sick child or young person, the pre- operative C&YP worried about "going to sleep and waking up during an operation ", the YP who has lived with a long term health condition, and has "had enough of being sick all the time"

The YP who feels so isolated that the only way to feel anything- is to harm themselves, and then tell no one.

 

C&YP look at situations that build stress levels and add to their emotional breakdown as "the worst thing that has ever happened to me".

 

A YP recently shared that he felt so let down by adults-

"who are supposed to be grown ups" he felt better leaving and sitting on the pavement in the middle of the road " because at least I can be seen"

 

When C&YP share those most intimate of thoughts with you, it can at times be overwhelming as the care giver, for those feelings lie deep within, and at times never leave.

 

 

As HCP's we could describe working alongside a C&YP in trauma in the following way-Being at the bow of the ship it may take a turn through uncharted waters sometimes, it may drop anchor and rest for a while, there may be storms,  and sometimes sunshine and blue sky's- but it may always be bumpy for some, it may always produce fears and anxieties.

As a SPP- working in a multi- skilled acute paediatric ward- the team and I help navigate and steer, support and explain- the why's and where's - the who's and whens'.

Sometimes we cannot answer everything, sometimes we don't know why..... What we can do is offer time,  be honest, be present and be prepared.

Trauma is also somewhat sneaky - it lerks like a Giant Jellyfish- underneath the calm waters of our ship- waiting - to glide through the water, and slowly tentacle by tentacle it latches on to the ship- making it sway, and rock and sting.

We are the ones charged with the elements, the abilities to listen, to engage, to care, to be kind, to tame the Jellyfish.

We are also the ones who have to be realistic, we are acutely aware of the constraints we face as HCP.

Health Play Specialists work alongside this trauma,  supporting the medical and clinical teams, providing a safer passage through stormy seas.

Explaining- listening, working through fears, and why they occur- the answer to that may be never known- that's the thing with Trauma - remember it's sneaky and if not shown the right way to swim- it may sting too much.

Recently I have been spending lots of time with families where trauma has occurred- many times over.

The look of horror, of disbelief will always remain my instigator to be who I am with these families- and how they allow me to be alongside them.

To gain a deeper level of understanding I have also had to do lots of reading and research- always learning and growing are what makes me able to continue to work with kindness and compassion.

Colby Pearce writes "It is not what children do, but why they do it- it is crucial to understanding them, and where intervening successfully with them"

Play will always remain my shining light- no matter of age or ability.

In trauma C&YP loose the ability to play, as a SPP I have the task of helping and supporting C&YP to restore the gift they have for play.

To use it - as it is the most powerful tool to use to build understanding and to process events- however negative and destructive they may be.

This week has seen Trauma and Resilience discussed on a larger scale at the recent conference of school nursing- #SNIC15- amazing work and processes have come out of that conference - and I was thrilled that we were able to read and take part via SoMe, @wecypns.

Our very own Children's Commissioner discussed how within the education and PSHE setting we can help to build resilience.

 

I finish this week with a few things- a sentence shared from a recent day I attended at The Institute of Arts in Therapy and Education

 

"Can a patient use the therapist to co-regulate fear and feeling?

They have to re-live the trauma to face, express, experience and arrive on the other side- and then they can regulate with support"

 

 A photograph of amazing courage- and growth- I am privileged to be part of.

 

 

 

Lastly 5 tips for the new HCP's who join our teams this week and will work alongside patients and there families who may be experiences many levels of trauma.

 

1- Always share #Hellomynameis and smile.

2. A favourite thing- begins conversations and breaks down clinical barriers

3. Clear and simple explanations- what is happening next and why. 

4. Stickers are amazing to give and receive ( TY @karmicgirl for reminding me)

5. There are never ever any silly questions.

 

Sian Spencer-Little